EGH ENT Instructional Fortnight 2017

(65) 9783 7711        (65) 6563 1602        sghENTfortnight@barakpco.com

Please check the relevant box for the course you are signing up for and complete the compulsory fields marked*.

DELEGATE’S NAME
*Title (please tick)
*Full Name (underline Family Name)
(To be printed on Name Badge/ Certificate)
Course Category 8th Head & Neck
7 - 9 Aug
1st Skull Base
10 - 11 Aug
21st Functional Endoscopic Sinus
12 - 14 Aug
14th Otology & Neuro-Otology
15 - 16 Aug
2nd Endoscopic Ear
21 - 22 Aug
1st Cochlear Implant
23 - 24 Aug
5th Sleep
25 - 27 Aug#
For Public
Full Course SGD 1500
(Include TORS observation)
* exclude TORS Hands On
SGD 1300
*have access to FESS lectures
SGD 1600 SGD 800 SGD 1500 SGD 1500 SGD 1500
* Basic + Advanced
- - - - - - SGD 1200
* Basic
Lectures + Observation SGD 380 SGD 380 SGD 800 SGD 400 SGD 500 SGD 500 SGD 700
Lectures Only SGD 280 SGD 280 SGD 600 SGD 250 SGD 250 SGD 400 -
TORS Hands On SGD 800 - - - - - -
TORS Observer Only SGD 250 - - - - - -
For Residents
Full Course SGD 750
(Include TORS observation)
* exclude TORS Hands On
SGD 650
*have access to FESS lectures
SGD 1200 SGD 600 SGD 1200 SGD 1200 -
Lectures + Observation SGD 280 SGD 280 SGD 400 - - - -
Lectures Only SGD 180 - SGD 300 - - - -

# First day of the Sleep Surgery course will include some lectures of the first day of Singapore Sleep Symposium 2017.

DELEGATE’S PARTICULARS & BILLING DETAILS
*Institution / Organisation
*Designation
*Billing Address
*Country
*Mobile / Cell Number
(Country code – Cell number)
*Email
*Dietary Restriction
(Food served will be Halal)

Payment Options

(to be drawn on a bank in Singapore)
Cheque / Bank draft No. Click here to enter text. payable to “Barak Conference Consultants Pte Ltd” is enclosed.
My Name, Contact Number and that the payment is meant for "SGH ENT Fortnight 2017" is written at the back of the cheque/ bank draft. It will be mailed to:

Barak Conference Consultants Pte Ltd
(SGH ENT Fortnight 2017 Secretariat)
10 Anson Road #26-04, International Plaza
Singapore 079903

I have remitted SGD Click here to enter text. through Click here to enter text. bank to the account below, stated that the payment is for “SGH ENT Fortnight 2017”. Attached is a copy of the remittance advice.

Beneficiary NameBarak Conference Consultants Pte Ltd

Bank NameOCBC Bank

Bank Address65 Chulia Street OCBC Centre Singapore 049513

Account No.641-19759-5001

Swift CodeOCBCSGSG

Important Payment Notes:

• Payment made by Telegraphic Transfer or Bank Draft should be made nett of all bank charges and commissions. Transfer commission is to be borne by the participant. All payments have to be in SGD.
• For Cheque or Bank Draft, please indicate your Name, Contact Number and that the payment is meant for "SGH ENT Fortnight 2017” at the back of the cheque/bank draft.
• For Telegraphic Transfer, please state on remittance advice that the payment is for "SGH ENT Fortnight 2017" and indicate your Name and Contact Number clearly. Upon completion of the transfer, please email a copy of your remittance advice with your Name to the Course Secretariat at sghENTfortnight@barakpco.com for tracking purposes.

The course secretariat will be in touch with you separately for payment via this mode. There will be a credit card charge of about 4.5% to be borne by the participant.

Terms and conditions

• Due to limited places available, registration will only be confirmed upon receipt of full payment, on a first-come, first-served basis.
• Registration fee is inclusive of GST.
• Residents are required to provide a proof of identity.

Cancellation Policy

• Any cancellation or replacement must be conveyed to the Organizer in writing. A cancellation fee of 50% of registration fee will be charged if the cancellation is received on or before 30 July 2017. There will be no refund of registration fee for cancellations made after the respective deadlines as stated above.
• The Organiser reserves the right to modify the programme. Full refund will be made should the course be cancelled due to unforeseen circumstances and all refunds will be made after the event.

PDPA Notices

1) By providing the information for registration, you confirm that you have read, understood and consent to the SingHealth Data Protection Policy, a copy of which is available at http://www.sgh.com.sg/Others/contact-us/Pages/PDPA.aspx.
2) Please note that photographs and videography may be taken during this event for publicity and training purposes.